The Female Athlete Triad is not just a woman's issue

In ultra-endurance running, females can be at risk for the Female Athlete Triad (FAT)–the interrelationship between energy availability, bone mineral density, and menstrual function. However, recent research indicates that the triad and energy deficiency are not merely female issues. Although male athletes will not lose their period, they can be at risk of low energy availability, bone loss, and hypogonadotropic hypogonadism (low production of sex hormones).

The parallels

A study in Sports Medicine Journal states that male endurance athletes can experience parallel symptoms as females diagnosed with the triad. Although irregular menstruation can often be the telltale sign for females, bone stress injuries are the more common sign of discovering triad-related symptoms in males. The triad for males involves the interrelationship of energy availability, bone health, and hormonal function.

In 2014 the International Olympic Committee (IOC) coined the term Relative Energy Deficiency in Sport (RED-S) to highlight that energy deficiency can be a risk for all athletes. Registered Dietician and endurance athlete Taryn Hand explains RED-S is “more inclusive and takes a bigger perspective on other physical and psychological effects.” Yet, the Female Athlete Triad Coalition argues that the IOC perspective neglects specifics of the triad essential for treatment. Sports medicine and sports science communities continue to collaborate in order to increase their understanding of RED-S in general.

Photo: A. Soggetti

The Male Athlete Triad

The Male Athlete Triad involves hormonal dysfunction in males, which manifests as hypogonadotropic hypogonadism. If a male athlete shows low testosterone, he may be prescribed a kind of hormone therapy that emulates what a female athlete diagnosed with amenorrhea would take. Alongside hormonal treatment, increasing caloric intake is essential for athletes experiencing symptoms of energy deficiency (RED-S).

Talking about it can be a first step in deconstructing bias (conscious or unconscious) that the athlete triad is a female issue. Although the triad or RED-S can exist with or without disordered eating, talking about our relationship with food and nutrition is essential for both male and female athletes. Trail running coach David Roche says “being open about it can be a first step for some people. Disordered eating in male athletes is common, and it’s okay to be going through something. Being open doesn’t make you less masculine.”

Trail running requires adequate training, nutrition, and rest for all genders. Research continues to evolve surrounding the complexities of RED-S and the triad. Continuing conversations surrounding male athletes and their experiences can help bring attention to future research that is needed.